Dipartimento Medico-Chirurgico di Scienze Cliniche, Tecnobiomediche e Medicina Traslazionale, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome, Italy.
Aliment Pharmacol Ther. 2013 Feb;37(4):375-82. doi: 10.1111/apt.12177. Epub 2012 Dec 10.
Pernicious anaemia (PA) has an increased risk for gastric cancer (GC). It is not established whether PA patients need to undergo endoscopic/histological follow-up.
To provide a systematic overview of the literature on PA and the development of gastric cancer, to estimate the gastric cancer incidence-rate.
According to PRISMA, we identified studies on PA patients reporting the incidence of gastric cancer. Quality of studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Meta-analysis on annual gastric cancer incidence rates was performed.
Twenty-seven studies met eligibility criteria. 7 studies were of high, 6 of medium, 10 of low and 4 of very low quality. Gastric cancer incidence-rates ranged from 0% to 0.2% per person-years in 7 American, from 0% to 0.5% in 2 Asiatic, from 0% to 1.2% in 11 Northern European studies and from 0% to 0.9% in 7 studies from other European countries. The incidence-rates of gastric cancer ranged from 0% to 1.2% per person-years in studies which used gastroscopy, from 0.1% to 0.9% in those based on International Classification of Disease. Heterogeneity between studies was not statistically significant at the 5% level (Chi-squared test = 17.9, P = 0.08). The calculated pooled gastric cancer incidence-rate was 0.27% per person-years. Meta-analysis showed overall gastric cancer relative risk in PA as 6.8 (95% CI: 2.6-18.1).
This systematic review shows a pooled gastric cancer incidence-rate in pernicious anaemia of 0.27% per person-years and an estimated nearly sevenfold relative risk of gastric cancer in pernicious anaemia patients. Further high quality studies are needed to confirm this higher risk.
恶性贫血（PA）发生胃癌（GC）的风险增加。PA 患者是否需要进行内镜/组织学随访尚不确定。
对 PA 患者和胃癌发展的文献进行系统综述，以评估胃癌的发病率。
根据 PRISMA 原则，我们确定了报道 PA 患者胃癌发病率的研究。使用纽卡斯尔-渥太华质量评估量表评估研究质量。对每年胃癌发病率进行了荟萃分析。
27 项研究符合入选标准。7 项研究质量为高，6 项为中，10 项为低，4 项为极低。7 项美国研究的胃癌发病率为 0%至 0.2%/人年，2 项亚洲研究为 0%至 0.5%/人年，11 项北欧研究为 0%至 1.2%/人年，7 项来自其他欧洲国家的研究为 0%至 0.9%/人年。使用胃镜的研究中胃癌发病率为 0%至 1.2%/人年，基于国际疾病分类的研究为 0.1%至 0.9%/人年。各研究之间的异质性在 5%水平上无统计学意义（卡方检验=17.9，P=0.08）。计算的胃癌合并发病率为 0.27%/人年。荟萃分析显示，PA 患者的总体胃癌相对风险为 6.8（95%CI：2.6-18.1）。
本系统综述显示恶性贫血患者的胃癌合并发病率为 0.27%/人年，估计恶性贫血患者的胃癌相对风险接近 7 倍。需要进一步开展高质量研究来证实这一更高的风险。
